Vermont may have abandoned the country’s only effort to enact single-payer health care, but one state legislator thinks the Affordable Care Act’s flaws will boost his cause.

New York state Assemblyman Richard Gottfried: "There’s now a lot more realization that you really can’t solve the problem by rehashing the current system." AP

There is perhaps no state lawmaker in the country who has pushed for single-payer health care with as much fidelity as New York state Assemblyman Richard Gottfried. Since 1992, he has introduced single-payer legislation every year, only to see his efforts fail to gain much traction. This year, Gottfried, a Manhattan Democrat and head of the Assembly’s health committee, is hopeful, though he may be the only legislator in the country making a full push. Pointing to “flaws” in the Affordable Care Act (ACA), Gottfried thinks the tide may be turning -- despite news that Vermont, the only state to enact a single-payer law, is abandoning its efforts.

Bills to create single-payer systems -- also known as “Medicare for all” -- have never been widespread. Still, there’s been a smattering of efforts over the years in California, Minnesota and Pennsylvania, among other states. In fact, the California Legislature twice passed single-payer bills, which former Gov. Arnold Schwarzenegger twice vetoed. State Sen. Mark Leno tried again in 2009 and 2011 before bowing out in 2013. “We went to the most progressive people and we could find no one who would introduce it,” says Don Bechler, who heads the San Francisco-based advocacy group Single Payer Now.

Jim Ferlo, a state senator from Pittsburgh, has led campaigns for single-payer legislation for more than five years in Pennsylvania. He retired at the end of November, but would like for another lawmaker to take up the cause. “Hope springs eternal,” he says.

Meanwhile, Minnesota state Sen. John Marty has routinely filed bills since 2007. But by the time Democrats controlled state government there in 2011, the ACA was front and center and Minnesota was behind in implementing it. “We were two years behind in setting up the exchange,” Marty says. “So regardless of the fact that some people think we need to go beyond the Affordable Care Act, the whole debate -- pro and con -- was all pro and con Affordable Care Act.” Marty says this year he plans to instead push a bill to study single payer along with other reform options in hopes of laying the groundwork for it further down the road.

News that Vermont won’t press ahead over concerns that a single-payer system would require too much new tax revenue will certainly dampen other single-payer efforts. And undoubtedly the ACA has already sucked the oxygen out of the debate for single payer in most states. The law has spurred arguments against a bigger government role in health care and it has dominated the attention of single-payer supporters who had to turn their energy toward implementing a law they don’t believe goes far enough in expanding coverage and holding down costs.

Despite this, New York’s Gottfried sees an opening. He is spending the winter crisscrossing upstate New York in an effort to garner more support for a single-payer system there. After years of fighting for a bill, he thinks he can capitalize on the ACA’s flaws. Among them: the ever-greater share of employee income consumed by health care as workers face larger and larger premiums and deductibles. “There’s now a lot more realization that you really can’t solve the problem by rehashing the current system,” he says.

There are also notable differences between Gottfried’s system and Vermont’s, which contained exemptions for some businesses and therefore limited the tax base. Still, Gottfried recognizes that political dynamics -- Republicans control the New York Senate -- might mean his plan is at least an election cycle away from prime time. “I’m realistic,” he says. “I’ve been carrying this bill for 22 years.”